Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational Cross-Sectional Study With Meta-Analysis.

IF 3.2 3区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Journal of Esthetic and Restorative Dentistry Pub Date : 2024-11-02 DOI:10.1111/jerd.13321
Ömer Hatipoğlu, João Filipe Brochado Martins, Mohmed Isaqali Karobari, Nessrin Taha, Thiyezen Abdullah Aldhelai, Daoud M Ayyad, Ahmed A Madfa, Benjamin Martin-Biedma, Rafael Fernández-Grisales, Bakhyt A Omarova, Wen Yi Lim, Suha Alfirjani, Kacper Nijakowski, Surendar Sugumaran, Xenos Petridis, Silvana Jukić Krmek, Dian Agustin Wahjuningrum, Azhar Iqbal, Imran Zainal Abidin, Martha Gallegos Intriago, Yasmine Elhamouly, Paulo Jorge Palma, Fatma Pertek Hatipoğlu
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Abstract

Objectives: This web-based survey, conducted across multiple countries, sought to explore the factors that impact the decision-making of clinicians when it comes to managing defective direct restorations.

Methods: A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations.

Results: Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision-making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries.

Conclusion: This study underscores the complexity of the decision-making process and the need for evidence-based guidelines to inform clinicians' decisions regarding restoration management. Patient-level factors predominantly influence decision-making, emphasizing the need for individualized approaches.

Clinical significance: The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth-level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians' decisions, often favoring replacement over repair. These findings underscore the necessity for evidence-based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

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修复与更换缺损直接牙修复体的临床决策:带 Meta 分析的多国横断面研究。
调查目的这项基于网络的调查在多个国家进行,旨在探讨影响临床医生在管理有缺陷的直接修复体时做出决策的因素:方法:通过各种网络平台向 21 个国家的牙医发送了一份包含 14 个问题的调查问卷。调查包括两个部分。第一部分包含五个有关人口统计学信息的问题,第二部分涉及八个临床情景。在第二部分,参与者的任务是决定是修复还是更换有缺陷的复合树脂和汞合金修复体:三千六百八十名牙科医生完成了调查。就复合树脂修复体而言,在部分脱落或断裂等情况下,修复是首选(RR:0.72;95% CI:0.58,0.89;P = 0.002),而在继发性龋齿的情况下,更换是首选(RR:2.43;95% CI:1.87,3.16;P 结论:本研究强调了决策过程的复杂性,以及临床医生在做出修复管理决定时需要循证指南。患者层面的因素是影响决策的主要因素,强调了个性化方法的必要性:研究显示,原始修复体的材料类型是一个关键的决定因素,复合材料修复体在特定情况下会被修复,而汞合金修复体在不同国家会被一致替换。患者和牙齿层面的关键因素,如龋坏风险高、口腔卫生差、修复体大小等,对临床医生的决定有很大影响,通常倾向于更换而不是修复。这些发现强调了循证指南的必要性,以帮助临床医生做出明智的选择,最终提高患者护理的质量。
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来源期刊
Journal of Esthetic and Restorative Dentistry
Journal of Esthetic and Restorative Dentistry 医学-牙科与口腔外科
CiteScore
6.30
自引率
6.20%
发文量
124
审稿时长
>12 weeks
期刊介绍: The Journal of Esthetic and Restorative Dentistry (JERD) is the longest standing peer-reviewed journal devoted solely to advancing the knowledge and practice of esthetic dentistry. Its goal is to provide the very latest evidence-based information in the realm of contemporary interdisciplinary esthetic dentistry through high quality clinical papers, sound research reports and educational features. The range of topics covered in the journal includes: - Interdisciplinary esthetic concepts - Implants - Conservative adhesive restorations - Tooth Whitening - Prosthodontic materials and techniques - Dental materials - Orthodontic, periodontal and endodontic esthetics - Esthetics related research - Innovations in esthetics
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